Association of Bariatric Surgery and Risk of Cancer in Patients With Morbid Obesity

Syed I. Khalid, MD; Samantha Maasarani, MD, MPH; Julia Wiegmann, MSCR; Aaron L. Wiegmann, MD, MS; Adan Z. Becerra, PhD; Philip Omotosho, MD; Alfonso Torquati, MD

Disclosures

Annals of Surgery. 2022;275(1):1-6.

Conclusion

Postoperative cancer rates were significantly lower in obese patients undergoing VSG or RYGB compared to bariatric-eligible patients without any surgical intervention.

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Table 1. 1:1 Exact Matched Population Descriptive Characteristics of Bariatric Patients
	Total n = 28,908	Vertical Sleeve Gastrectomy (VSG) n = 9636	Roux-en-Y Gastric Bypass (RYGB) n = 9636	Bariatric Eligible No Surgery n = 9636	P
Age, n (%)
≤34	6732 (23.29)	2244 (23.29)			>0.99
35–44	8700 (30.10)	2900 (30.10)
45–54	8328 (28.81)	2776 (28.81)
55–64	4971 (17.20)	1657 (17.20)
65–69	177 (0.61)	59 (0.61)
Sex, n (%)
Female	23,742 (82.13)	7914 (82.13)			>0.99
Male	5166 (17.87)	1722 (17.87)
Comorbidities, n (%)
Hypertension	14,658 (50.71)	4886 (50.71)			>0.99
Coronary artery disease	1812 (6.27)	604 (6.27)			>0.99
Congestive heart failure	486 (1.68)	162 (1.68)			>0.99
Diabetes mellitus, type II	11,940 (41.30)	3980 (41.30)			>0.99
Chronic kidney disease	477 (1.65)	159 (1.65)			>0.99
Nonalcoholic fatty liver disease	939 (3.25)	313 (3.25)			>0.99
Osteoarthritis	8655 (29.94)	2885 (29.94)			>0.99
Obstructive sleep apnea	11,004 (38.07)	3668 (38.07)			>0.99
Chronic obstructive pulmonary disease	5787 (20.02)	1929 (20.02)			>0.99
Smoking	4002 (13.84)	1334 (13.84)			>0.99
5-y Cancer outcome n (%)
Any cancer type	1127 (3.90)	334 (3.47)	349 (3.62)	444 (4.61)	0.001
Breast cancer	409 (1.41)	124 (1.29)	132 (1.37)	153 (1.59)	0.063
Colorectal cancer	121 (0.42)	40 (0.42)	26 (0.27)	55 (0.57)	0.002
Esophageal adenocarcinoma	3 (0.01)	0 (0.00)	2 (0.02)	1 (0.01)	0.123
Gallbladder cancer	5 (0.02)	1 (0.01)	1 (0.01)	3 (0.03)	0.150
Gastric cancer	31 (0.11)	14 (0.15)	10 (0.10)	7 (0.07)	0.101
Liver cancer	50 (0.17)	11 (0.11)	14 (0.15)	25 (0.26)	0.013
Lung cancer	91 (0.31)	20 (0.21)	23 (0.24)	48 (0.50)	0.001
Meningioma	3 (0.01)	0 (0.00)	1 (0.01)	2 (0.02)	0.123
Multiple Myeloma	22 (0.08)	7 (0.07)	6 (0.06)	9 (0.09)	0.242
Ovarian cancer	72 (0.25)	17 (0.18)	14 (0.15)	41 (0.43)	0.001
Pancreatic cancer	19 (0.07)	5 (0.05)	5 (0.05)	9 (0.09)	0.144
Prostate cancer	56 (0.19)	16 (0.17)	26 (0.27)	14 (0.15)	0.036
Renal cancer	74 (0.26)	24 (0.25)	20 (0.21)	30 (0.31)	0.117
Thyroid cancer	134 (0.46)	38 (0.39)	50 (0.52)	46 (0.48)	0.144
Uterine cancer	195 (0.67)	54 (0.56)	58 (0.60)	83 (0.86)	0.007

Table 2. Odds of Developing Various Cancers Within 5 Years Among 1:1 Exact Matched Bariatric Patients Who Underwent Vertical Sleeve Gastrectomy or Roux-en-Y Gastric Bypass compared to Bariatric Eligible No Surgery Cohort
	VSG Odds Ratio (95% CI)	RYGB Odds Ratio (95% CI)
Any cancer type	0.743 (0.643–0.859)	0.778 (0.674–0.898)
Breast cancer	0.808 (0.637–1.026)	0.861 (0.681–1.088)
Colorectal cancer	0.726 (0.483–1.092)	0.471 (0.295–0.752)
Esophageal adenocarcinoma	—	2.000 (0.181–22.062)
Gallbladder cancer	0.333 (0.035–3.204)	0.333 (0.035–3.204)
Gastric cancer	2.001 (0.807–4.961)	1.429 (0.544–3.756)
Liver cancer	0.439 (0.216–0.893)	0.559 (0.291–1.077)
Lung cancer	0.415 (0.246–0.700)	0.478 (0.290–0.786)
Meningioma	—	0.500 (0.045–5.514)
Multiple myeloma	0.778 (0.289–2.089)	0.666 (0.237–1.872)
Ovarian cancer	0.414 (0.235–0.729)	0.341 (0.186–0.625)
Pancreatic cancer	0.555 (0.186–1.658)	0.555 (0.186–1.658)
Prostate cancer	1.143 (0.558–2.343)	1.859 (0.970–3.563)
Renal cancer	0.800 (0.467–1.369)	0.666 (0.378–1.174)
Thyroid cancer	0.825 (0.537–1.270)	1.087 (0.728–1.625)
Uterine cancer	0.649 (0.460–0.915)	0.697 (0.498–0.976)